Beriberi Outbreak among Myanmar and Thai workers in a Factory in Chachoengsao Province, Thailand, 2012-2013

Abstract

Beriberi is a clinical syndrome which develops from prolonged severe thiamine deficiency in diet. In July 2013, the Ministry of Public Health, Thailand received reports of three deaths among Myanmar workers in a factory. We identified suspect beriberi cases, reviewed clinical history and conducted a survey among both Myanmar and Thai workers in the factory. Blood thiamine levels were measured and foods served in the factory canteen were also examined. Seventeen suspect cases (attack rate = 17%) were identified, with median age of 26 years (range 20-30 years) and male to female ratio of 3.3:1. All fatalities were young men (case fatality proportion = 17.6%). Prevalence of thiamine deficiency among Myanmar and Thai workers were 7.1% (95% CI = 0-22.0) and 26.7% (95% CI = 1.3-52.0) respectively. This outbreak was likely to be caused by long exposure to low thiamine intake and heavy physical activities. After distributing thiamine supplements and improving diet, no more cases occurred. We recommended improving hospital staff’s ability to differentiate beriberi from other cardiomyopathies and neurologic diseases, and raising awareness of thiamine deficiency in this area.